Coronary heart disease risk equivalence in diabetes depends on concomitant risk factors
Coronary heart disease risk equivalence in diabetes depends on concomitant risk factors
复制标题
DOI：
10.2337/diacare.29.02.06.dc05-1299
复制
发表时间：
2006-02-01
期刊：
影响因子：
16.2
通讯作者：
Devereux, RB
中科院分区：
文献类型：
--
作者：
Howard, BV;Best, LG;Devereux, RB
研究设计与方法：在糖尿病高发人群(n=4,549)中，研究了单危险因素和多危险因素对糖尿病和非糖尿病男性和女性致命性和非致命性冠心病和心血管疾病(CVD)10年累积发病率的影响。结果：在糖尿病高发人群(n=4,549)中，糖尿病增加了CHD风险(男性和女性风险比分别为1.99和2.93)。糖尿病男性和女性的10年累积冠心病发病率分别为25.9%和19.1%，而非糖尿病男性和女性既往冠心病的累积发病率分别为57.4%和58.4%。当只考虑致命事件时，这一模式类似。具有一个或两个危险因素的糖尿病患者10年累计冠心病发病率仅为非糖尿病患者(14%)的1.4倍。然而，有多种危险因素的糖尿病受试者的10年冠心病发病率为40%，而且这些受试者的致命性冠心病的发生率高于既往有冠心病病史的非糖尿病受试者。心血管疾病的数据显示出类似的模式，按性别进行的单独分析也是如此。结论--我们的结果以及与其他现有数据的比较显示，糖尿病患者的冠心病发病率存在很大差异，这取决于人口和现有的危险因素。大多数人的10年累积发病率为20%，但只有那些具有多种危险因素的人的10年累积发病率与冠心病患者相当。在获得更多数据之前，谨慎的做法可能是根据整个风险因素概况而不只是糖尿病的存在来考虑目标。
OBJECTIVE - Diabetes has been defined as a coronary heart disease (CHD) risk equivalent, and more aggressive treatment goals have been proposed for diabetic patients.RESEARCH DESIGN AND METHODS - We studied the influence of single and multiple risk factors on the 10-year cumulative incidence of fatal and nonfatal CHD and cardiovascular disease (CVD) in diabetic and nondiabetic men and women, with and without baseline CHD or CVD, in a population (n = 4,549) with a high prevalence of diabetes.RESULTS - in both sexes, diabetes increased the risk for CHD (hazard ratio 1.99 and 2.93 for men and women, respectively). Diabetic men and women had a 10-year cumulative incidence of CHD of 25.9 and 19.1%, respectively, compared with 57.4 and 58.4% for nondiabetic men and women with previous CHD. The pattern was similar when only fatal events were considered. Diabetic individuals with one or two risk factors had a 10-year cumulative incidence of CHD that was only 1.4 times higher than that of nondiabetic individuals (14%). However, the 10-year incidence of CHD in diabetic subjects with multiple risk factors was > 40%, and the incidence of fatal CHD was higher in these subjects than in nondiabetic subjects with previous CHD. Data for CVD showed similar patterns, as did separate analyses by sex.CONCLUSIONS - Our results and comparisons with other available data show wide variation in the rate of CHD in diabetes, depending on the population and existing risk factors. Most individuals had a 10-year cumulative incidence > 20%, but only those with multiple risk factors had a 10-year cumulative incidence that was equivalent to that of patients with CHD. Until more data are available, it may be prudent to consider targets based on the entire risk factor profile rather than just the presence of diabetes.